And just when I thought it couldn't get better...

I had the best day today... an emotional high from early this morning well through getting home this evening. Starting at the beginning... (because generally that's a good place to start)

When I got to the unit and pre-rounded on the babies I'm following, everybody looked good. I made the decision that I thought one was ready to come off CPAP, and cleared it with my attending. Yay for tube-free babies!
Then I went to look up labs, xrays, etc to prepare for rounds and was talking to one of the residents when I found out that not only were none of them on call today, the three that were there this morning had clinic in the afternoon. This means there was a lonely little delivery pager going to be sitting all by itself.... or not :)

Clipped the pager on about 8:30... finished prerounds and plans and started rounds. We were about halfway through when the pager went off for the first time. Off to the delivery room. Big baby, fairly healthy, just a little extra work of breathing. After watching him for a while, the NNP decided to send him on to the transition nursery. The rest of rounds went by without issue and we got done really early.

My amazing mentor/attending then called to take me to lunch for my last day :) We had a great lunch and then went over my presentation for tomorrow, giving it the final touches. I told her I wanted to hang out in the unit for a while and see if anything interesting would happen because the delivery board was full and several of them were preemies.

Went to check on the twins and ok'd mom holding... for the first time. This was what I thought would be the most inspiring and rewarding moment of my day. Then.....

Got settled at my desk about two to review test results and... beeep.. 911. That means RUN, not walk, not elevator... scale the stairs two to three at a time. When I get in the room, it's just me and the delivery nurse... and in runs the resident OB with a tiny bundle. On the warmer is delivered the smallest person I've ever seen. For what seemed like an eternity, I got the initial heart rate and had the fleeting thought of fear as an NNP hadn't responded yet. Thankfully, she was there almost as soon as the thought went through my head. I gladly stepped back from the head of the bed on that one and had her take over for the intubation, assuming a first-assistant role. Fast forward through all the medical details and you'll be pleasantly surprised to know that AMAZING child, God's perfect creation, looks more alive than anyone ever thought possible. A fighter, we say. And even though the odds are stacked against him, this part deep inside of me is almost sure he'll make it.

As he's settling into his bed and I'm beginning to catch my breath, beeep... 911. Adrenaline rush, straight back to the second floor. This one we at least beat to the room. A little bigger, a little stronger. But still tiny. Heart rate, intubate. And in the meantime, realize the child's head is bleeding... profusely. Stitches in the resuscitation room? Has that ever been done? The prayers go up. Pressure is applied, the intubation is complete, we watch and wait. The bleeding slows and the baby improves. It's off to the transport incubator, and down to meet the new friend across the hall, who was born less than an hour before, 7 weeks more premature.

As I signed out tonight, returned the delivery pager to the front desk, and said a few goodbyes, I found myself less sad than I thought I'd be. Maybe because I was exhausted, but maybe because God allowed me to have an amazing last day, showing me how much work He's done in me this summer and the endless blessings He has in store. This time last year, I said I wanted to be a neonatologist and save babies. Now I've tried my hand at it. Is it stressful? Of course. Trauma-heavy? Definitely. Hardcore? Some say so. Devastating? Some days. Rewarding? Everyday.

I may not be spending 8-10 hours a day in the NICU in the coming months or years, but I'll be there as much as possible... and my heart will never leave. I carry a tiny footprint to remind me of what's on the other side.

This IS the rest of my life. Welcome to it. :)

Call night... and the end of week 1... never trust a preemie

Wednesday night I completed another first on my list for the summer. I took call with my attending physician. I actually carried a resident pager, slept in house, and responded with the residents/nurse practitioners. It was super cool - very little sleep involved, but very much worth it. I've learned in just a week that I am EXACTLY where I am supposed to be doing EXACTLY what God has called me to do. It is an amazing feeling... a blessing, and huge responsibility. I couldn't be happier. Even with the story I'm about to share.

Almost as soon as I clipped the pager on wednesday night, a baby started "crumping" (medical terminology for falling apart with no known cause). Blood gases were off, oxygen sats were bad... the kid just looked sick. Really sick. She'd been sick for a while (and touch and go a few times), but suddenly I found myself watching a full out resuscitation effort. The IV access was poor and it was determined that she wasn't receiving all her meds (causing the other problems), so the nurses and doctors tried again. And again. Finally surgery was consulted to put a line in. For what seemed like an eternity, the ventilator was off and Andrea was hand-bagged while the surgeons tried to get access. It took much longer than anyone anticipated, and she lost a lot of blood. A lot, in the nicu, is about the equivalent of what you and I would get if we sliced our finger open. Not even enough to go to the hospital for stitches. But this kid needed blood, and fast. All the appropriate tests were run and the blood was brought up. Enough blood to fill a medium size syringe. Wouldn't volume-expand a grown person at all - but it was enough to replace Andrea's entire supply. And mind you, she was a "big kid" (once again - "big" is relative... in the NICU, >3 lbs is big and 5+ is huge). With central access and medications finally being delivered, she seemed to improve slightly. Not enough to admit success, but enough to return her to the ventilator, and for us to return to the family in the waiting room (who had been called from several hours away to be at the bedside). Deep breath, babydoc. Put on the white coat. Get ready. This is the not fun part, my attending says. It's never easy to gently tell a family that their baby may die. Or has died. You don't have to come with me, she says. But I put on my coat, she puts on hers, and out we go. To do the job no one ever wants to have to do. Even at this time, it was admittedly easier than I expected. The family has experienced these "crumps" before. She'll come around, they say. And who are we to say otherwise? Preemies can never be trusted. You really just don't know.

At this moment, the delivery pager goes off and I race upstairs to find quite the opposite - a bouncing, beautiful, perfect, and HUGE healthy newborn. Couldn't be pinker. Couldn't have better APGARs. This one gets to bypass our unit directly. And transition. She's a direct admit to the newborn nursery, or mom's bedside. We smile and coo with her... encouraging the first-time parents and sharing in their intimate moment.

It's how things change in neonatology. It's the moments of birth and neardeath, often intertwined, with no fine line of delineation. The uncertainty of medical knowledge and the certainty of God's ultimate healing - no matter what our role in that may or may not be.

The night continued fairly quiet, with a little (about an hour) rest in between. Post call, I left the hospital about 9-10 and had a full day off. This morning, I returned to the hospital fresh. In Grand Rounds, I sat with a couple of my classmates who are also doing my program but are in different areas of the children's hospital. Close to time for conference to start, the residents I'm working with filed in. A sat down next to me, and I asked how his call night was. "Baby Andrea died" was all he had to say. And I knew. "She went peacefully, and very quickly, early in the night... by the time the nurse took her off the vent to listen for any signs of pulse/breath sounds/heart sounds, it was over."

But for me, she didn't go quickly. A baby born too soon, and taken too late. It's never easy, I suppose. Part of me wonders if it would've been easier if she would've been a micropreemie, a <1 lber, a brand new admission. The other part knows it wouldn't have made any difference. It was my first live patient to lose. I held her hand for that treacherous hour, while the surgeon desperately attempted to get us access so she could get the drugs (and now blood) she had to have. While my attending tirelessly hand-ventilated her, never growing angry, never showing fear or trepidation (Stay calm, always, she said. The babies know. They always know. If you're afraid, they're afraid). We worked as a team - doctors, nurses, xray, respiratory, surgery - and kept her alive night after night. But preemies can't be trusted. They decide if they are going to get better, they decide if they are going to die. Personally, I think they've got a direct line to God. Andrea decided that sitting in His lap was better than in her incubator, surrounded by all that medical technology and the twenty-first century had to offer. And once again, the preemie knows best. She is healed and perfect, resting peacefully in His arms.

And I will never be the same. I know it'll never get easier, and yet I can't imagine a life of doing anything else. I'm home in the NICU. I'm home in the quiet and "scary" parts of the hospital, where no other outside physicians like to go. I've found my calling doing God's work here. And I'll never be able to forget that it is indeed HIS work, not my own, that I am doing. Goodnight, baby Andrea. I can't wait to meet you again in Heaven!

Last week

Last week of work. It's bittersweet- the long weekend totally ruined me and made me look forward to the sleeping in days, but of course I'm going to miss everyone here. Seems like forever ago and just yesterday that I got the news I was accepted and decided on May 29th as my last day of work.

I'm so excited to get moved and settled in to a routine. Looking forward to spending my days in the lecture halls, and really looking forward to being in the hospital/clinic again. In post-bacc and master's work, there were times I felt l couldn't do any more. Those days, I shadowed or volunteered.. found a place where I was needed, made a difference, and remembered the reason for all the work. It never failed, the next morning I was good to go again. To touch just one child is to make a difference - to touch so many is something I stand in awe at. I saw one of the kids I assisted on in the NICU last summer recently - she's a bright, happy, healthy one year old that is doing so well. It's amazing to see miracles in action.

Work is busy so far this week, which is good. The days and goodbyes won't drag.

Please keep me in prayer this week as I get ready to say my goodbyes/see-you-laters to a world I've become so accustomed to over the past six years. Also please be in prayer for a special little boy who is fighting for his life in the Batson PICU. I've grown to love him through his blog alone, and I can only imagine the wonderful person he truly is. I'm sure his family would appreciate any extra prayers you guys can afford to him.

The end of an era...

Last night was the final night of my final class at Carey. It was a bittersweet night. I was glad to be done, but at the same time I was sad to be at the end of a road I've traveled for so long. I didn't get melancholy when I finished my undergrad because I knew I was returning for post-bacc and master's work. This time, it's real. And real is scary.

I'm excited and terrfied. I can't wait to get started, but jumping into the unknown is frightening. I'll feel a lot better once I get settled and get started. Leaving is the hardest part.

I've never been good at goodbyes, and I guess I never will be.